Glycaemic efficacy and safety of linagliptin for the management of non-cardiac surgery patients with type 2 diabetes in a real-world setting: Lina-Surg study

Abstract

<b>Introduction:</b> The use of dipeptidyl peptidase-4 inhibitors in hospitalized patients is an area of active research. We aimed to compare the efficacy and the safety of the basal-bolus insulin regimen versus linagliptin-basal insulin in non-critically ill non-cardiac surgery patients in a real-world setting. <b>Methods:</b> We enrolled patients with type 2 diabetes hospitalized in non-cardiac surgery departments with admission glycated haemoglobin level < 8%, admission blood glucose concentration < 240 mg/dL, and no at-home injectable treatments who were treated with basal-bolus (<i>n</i> = 347) or linagliptin-basal (<i>n</i> = 190) regimens between January 2016 and December 2017. To match patients on the two regimens, a propensity matching analysis was performed. <b>Results:</b> After matching, 120 patients were included in each group. No differences were noted in mean blood glucose concentration after admission (<i>p</i> = .162), number of patients with a mean blood glucose 100-140 mg/dL (<i>p</i> = .163) and > 200 mg/dL (<i>p</i> = .199), and treatment failures (<i>p</i> = .395). Total daily insulin and number of daily insulin injections were lower in the linagliptin-basal group (both <i>p</i> < .001). Patients on linagliptin-basal insulin had fewer hypoglycaemic events (blood glucose < 70 mg/dL) (<i>p</i> < .001). <b>Conclusion:</b> For type 2 diabetes surgery patients with mild to moderate hyperglycaemia without pre-hospitalization injectable therapies, linagliptin-basal insulin was an effective, safe alternative with fewer hypoglycaemic events in real-world practice. Key messages Treatment with basal-bolus insulin regimens is the standard of care for non-critically ill hospitalized patients with type 2 diabetes. A differentiated treatment protocol that takes into account glycaemic control and clinical factors should be implemented in the hospital setting. Linagliptin-basal insulin is an effective, safe alternative with fewer hypoglycaemic events during the hospitalization of non-critically ill non-cardiac surgery patients with T2D in real-world practice.